Provider Demographics
NPI:1447302088
Name:STEWART, EDWARD ALLEN I (EDWARD STEWART DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ALLEN
Last Name:STEWART
Suffix:I
Gender:M
Credentials:EDWARD STEWART DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 WESSEX CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-8122
Mailing Address - Country:US
Mailing Address - Phone:919-734-4459
Mailing Address - Fax:
Practice Address - Street 1:1213 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-2616
Practice Address - Country:US
Practice Address - Phone:910-814-2944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC71841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7990128Medicaid